title: Hypercoagulability following blunt solid abdominal organ injury: when to initiate anticoagulation.
abstract: BACKGROUND
  The optimal time to initiate venous thromboembolism pharmacoprophylaxis after blunt abdominal solid organ injury is unknown.
  
  
  METHODS
  Postinjury coagulation status was characterized using thromboelastography (TEG) in trauma patients with blunt abdominal solid organ injuries; TEG was divided into 12-hour intervals up to 72 hours.
  
  
  RESULTS
  Forty-two of 304 patients (13.8%) identified underwent multiple postinjury thromboelastographic studies. Age (P = .45), gender (P = .45), and solid organ injury grade (P = .71) were similar between TEG and non-TEG patients. TEG patients had higher Injury Severity Scores compared with non-TEG patients (33.2 vs 18.3, respectively, P < .01). Among the TEG patients, the shear elastic modulus strength and maximum amplitude values began in the normal range within the first 12-hour interval after injury, increased linearly, and crossed into the hypercoagulable range at 48 hours (15.1 ± 1.9 Kd/cs and 57.6 ± 1.6 mm, respectively; P < .01, analysis of variance).
  
  
  CONCLUSIONS
  Patients sustaining blunt abdominal solid organ injuries transition to a hypercoagulable state approximately 48 hours after injury. In the absence of contraindications, pharmacoprophylaxis should be considered before this time for effective venous thromboembolism prevention.
authors.affiliation: Department of Surgery, Denver Health Medical Center, University of Colorado Health Sciences Center, 777 Bannock Street MC0206, Denver, CO 80206, USA.
authors.forename: Brandon C
authors.initials: BC
authors.lastname: Chapman
authors.forename: Ernest E
authors.initials: EE
authors.lastname: Moore
authors.forename: Carlton
authors.initials: C
authors.lastname: Barnett
authors.forename: Robert T
authors.initials: RT
authors.lastname: Stovall
authors.forename: Walter L
authors.initials: WL
authors.lastname: Biffl
authors.forename: Clay C
authors.initials: CC
authors.lastname: Burlew
authors.forename: Denis D
authors.initials: DD
authors.lastname: Bensard
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Jurkovich
authors.forename: Fredric M
authors.initials: FM
authors.lastname: Pieracci
mesh_terms: D000007:Abdominal Injuries / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D000328:Adult; D001777:Blood Coagulation; D001803:Blood Transfusion / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D012189:Retrospective Studies; D013916:Thrombelastography; D019851:Thrombophilia / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D014949:Wounds, Nonpenetrating / Q000097:blood / Q000150:complications* / Q000175:diagnosis
keywords: Blunt solid organ injury; Hypercoagulable; Trauma